The EURO-FORTA (Fit fOR The Aged) List: International Consensus Validation of a Clinical Tool for Improved Drug Treatment in Older People
The EURO-FORTA (Fit fOR The Aged) List: International Consensus Validation of a Clinical Tool for Improved Drug Treatment in Older People
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DOI：
10.1007/s40266-017-0514-2
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发表时间：
2018-01-01
期刊：
影响因子：
2.8
通讯作者：
Wehling, Martin
中科院分区：
文献类型：
--
作者：
Pazan, Farhad;Weiss, Christel;Wehling, Martin
背景：在许多情况下，老年人的药物治疗仍然可能是不合适的，因为多种疾病和相关的多种药物非常普遍。为了提高老年人药物治疗的质量，FORTA（适合老年人）清单（2012年第一版）是由来自德国和奥地利的21位专家在德尔菲共识程序中制定并更新的（FORTA2015）。它已在一项随机、对照、前瞻性试验中得到验证，显示在药物治疗质量和临床终点（VALFORTA）方面有显著改善。方法在此基础上，对英国、法国、波兰、意大利、西班牙、北欧国家和荷兰等国家/地区的FORTA清单进行德尔菲共识验证（两轮）。使用基于老年药理学专业知识、出版物和专业职位的算法来寻找该领域的专家。结果47名专家同意参与德尔菲程序，成功率为97.9%。对于每个国家/地区，总体平均共识系数（与发起人提案的偏差）为[0.9]。来自六个国家和地区的FORTA清单，至少有四名专家参与（荷兰除外），加上原始的FORTA清单，被整理成EURO-FORTA清单，包含26个主要适应症组的264个项目。至少有4个国家或地区提议在拟议项目中增加两种药物；没有一个需要移除。该项目产生了七个新的国家/地区特定的FORTA清单，以及总体的欧洲-FORTA清单，显示出基于更广泛的专家基础的高度共识水平。EURO-FORTA应该有助于在国际上推广FORTA方法并改善老年药物治疗。
Background Drug treatment of older people is still potentially inappropriate in many cases as multimorbidity and related polypharmacy are highly prevalent. To increase the quality of drug treatment in older people, the FORTA (Fit fOR The Aged) List (first version 2012) was developed in a Delphi consensus procedure and updated (FORTA2015) by 21 experts from Germany and Austria. It has been validated in a randomized, controlled, prospective trial demonstrating significant improvement in the quality of drug treatment and clinical endpoints (VALFORTA).Methods Based on these results, Delphi consensus validations (two rounds) of countryregion-specific FORTA Lists were conducted in the UKIreland, France, Poland, Italy, Spain, the Nordic countries and The Netherlands. An algorithm based on geriatricpharmacologic expertise, publications and professional position was used to find experts in the field.Results Forty-seven experts agreed to participate in the Delphi process (return rate of 97.9%). For each country/ region, the overall mean consensus coefficient (deviation from the initiator proposal) was [0.9. FORTA Lists from six countriesregions with a minimum of four participating experts (excluding The Netherlands) plus the original FORTA List were collated into the EURO-FORTA List containing 264 items in 26 main indication groups. Two drugs had to be added to the proposed items, as proposed by at least four countriesregions; none had to be removed.Conclusion This project produced seven new country/region- specific FORTA Lists, as well as the overarching EURO-FORTA List showing a high consensual level based on a broader expert base. EURO-FORTA should help to spread the FORTA approach and improve geriatric pharmacotherapy internationally.